Leave Of Absence Request Form (Page 2 of 2) in pdf

Leave Of Absence Request Form Page 2

Leave of Absence Request Form (page 2)

PRIVACY NOTIFICATION

The State of California Information Practices Act of 1977 (effective July 1, 1978) requires the

University to provide the following information to individuals who are asked to supply

information.

The principal purpose for requesting the information on this form is to process requests for leaves

of absence. The Federal Family and Medical Leave Act of 1993 and University policy authorize

maintenance of this information.

Information furnished on this form may be used by various University departments for benefits,

payroll and personnel administration, and will be transmitted to the Federal and State

governments as required by law.

Individuals have the right to review their own records in accordance with University personnel

policy and collective bargaining agreements. Information on applicable policies and agreements

can be obtained from campus or Office of the President Staff and Academic Personnel Offices.

The officials responsible for maintaining the information contained on this form are: Campus

Departments or Campus Accounting Officers.

Leave Of Absence Request Form Page 2